455001248-2-6-2023-25-AS-KHOS-CPAQPZ-20230222112134

Community Care Licensing

COMPLAINT INVESTIGATION REPORT

Facility Number: 455001248
Report Date: 02/06/2023
Date Signed: 02/06/2023 10:13:57 AM

Unsubstantiated

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

This is an official report of an unannounced visit/investigation of a complaint received in our office on
11/21/2022 and conducted by Evaluator Donna Gurriere

COMPLAINT CONTROL NUMBER: 25-AS-20221121143930

FACILITY NAME:	WILLOW SPRINGS ALZHEIMER'S SPECIAL CARE CTR.		FACILITY NUMBER:	455001248
ADMINISTRATOR:	GOSTAS, DARIEN		FACILITY TYPE:	740
ADDRESS:	191 CHURN CREEK ROAD		TELEPHONE:	(530) 242-0654
CITY:	REDDING	STATE: CA	ZIP CODE:	96003
CAPACITY:	56	CENSUS: 39	DATE:	02/06/2023
		UNANNOUNCED	TIME BEGAN:	10:00 AM
MET WITH:	PATRICIA CLARK		TIME COMPLETED:	10:30 AM

ALLEGATION(S):

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Facility is not taking necessary precautions to prevent the spread of scabies.
Facility failed to report scabies outbreak.

INVESTIGATION FINDINGS:

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Donna Gurriere, Licensing Program Analyst was in contact and met with Patricia Clark, Administrator. Allegation is that the Facility is not taking necessary precautions to prevent the spread of scabies and the Facility failed to report scabies outbreak.

LPA Gurriere completed the required COVID-19 testing protocols, and a daily self-screening questionnaire for symptoms of COVID 19 infection to affirm no COVID-19 related symptoms. The administrator/staff person was contacted to complete a facility risk assessment. LPA Gurriere ensured that hand sanitizer was applied before entering the facility and the following Personal Protective Equipment (PPE) was worn: Surgical mask. Additionally, LPA Gurriere was screened by a staff person upon entering the facility.

continued

Unsubstantiated

Estimated Days of Completion:

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC9099 (FAS) - (06/04)

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Control Number 25-AS-20221121143930

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)

CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CHICO - RESIDENTIAL, 520 COHASSET RD., STE. 170
CHICO, CA 95926

FACILITY NAME: WILLOW SPRINGS ALZHEIMER'S SPECIAL CARE CTR.	FACILITY NUMBER: 455001248
	VISIT DATE: 02/06/2023

NARRATIVE

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Facility is not taking necessary precautions to prevent the spread of scabies.
During the investigative process, the administrator and five staff persons were interviewed. An attempt was made to interview two residents; however, both have a type of dementia and were not able to answer the questions. Supportive documents were submitted to include Voicefriend messages, incident report, notification letter to staff and an email timeline of procedures for the scabies outbreak.

During the interview process, staff indicated that the facility did have a scabies outbreak and that the administrator took the appropriate actions to eliminate scabies from the facility. Steps that were taken included ensuring that residents, family members and staff were notified of the outbreak. Medications were available for all staff and the residents to begin the scabies treatment. Additionally, notification was provided to staff to disinfect their homes, per the Shasta County Public Health guidelines and isolation was encouraged for the residents.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

Facility failed to report scabies outbreak.
During the investigative process, the administrator and five staff persons were interviewed. An attempt was made to interview two residents; however, both have a type of dementia and were not able to answer the questions.

During the interview process, supportive documents were submitted to include Voicefriend messages, incident report, notification letter to staff and an email timeline of steps implemented for the scabies outbreak. Numerous reporting types of communication were submitted to the licensing agency for review.

Although the allegation may have happened, or is valid, there is not a preponderance of evidence to prove that the alleged violation occurred, and the findings are Unsubstantiated.

SUPERVISOR'S NAME: Lauren Crocker	TELEPHONE: (916) 261-4966
LICENSING EVALUATOR NAME: Donna Gurriere	TELEPHONE: (916) 263-4700
LICENSING EVALUATOR SIGNATURE:	DATE: 02/06/2023

I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.

FACILITY REPRESENTATIVE SIGNATURE:

DATE: 02/06/2023

LIC9099 (FAS) - (06/04)

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